Self-Image and Sexuality
Each of us has a mental picture of how we look, our "self-image." Although we may not always like how we look, we're used to our self-image and accept it. But cancer and its treatment can change how you look and feel about yourself. Know you aren't alone in how you feel. Many others have similar feelings.
Body Changes during and after Treatment
Some body changes are short-term while others will last forever. Either way, your looks may be a big concern during or after treatment. For example, people with ostomies after colon or rectal surgery are sometimes afraid to go out. They worry about carrying equipment around or fear that it may leak. Some may feel ashamed or afraid that others will reject them.
Every person changes in different ways. Some will be noticeable to other people, but some changes only you will notice. For some of these you may need time to adjust. Issues you may face include:
- Hair loss or skin changes
- Scars or changes in the way you look caused by surgery
- Weight changes
- Loss of limbs
- Loss of fertility, which means it can be hard to get pregnant or father a child
Even if others can't see them, your body changes may trouble you. Feelings of anger and grief about changes in your body are natural. Feeling bad about your body can also lower your sex drive. This loss may make you feel even worse about yourself.
Changes in the way you look can also be hard for your loved ones, which in turn, can be hard on you. For example, parents and grandparents often worry about how they look to a child or grandchild. They fear that changes in their appearance may scare the child or get in the way of their staying close.
Coping with Body Changes
How do you cope with body changes?
- Mourn your losses and know it's okay to feel sad, angry, and frustrated. Your feelings are real, and you have a right to grieve.
- Try to focus on the ways that coping with cancer has made you stronger, wiser, and more realistic.
- If your skin has changed from radiation, ask your doctor about ways you can care for it.
- Look for new ways to enhance your appearance. A new haircut, hair color, makeup, or clothing may give you a lift. If you're wearing a wig, you can take it to a hairdresser to shape and style.
- Talk to other patients for advice.
- If you choose to wear a breast form (prosthesis), make sure it fits you well. Don't be afraid to ask the clerk or someone close to you for help. And check your health insurance plan to see if it will pay for it.
Coping with these changes can be hard. But, over time, most people learn to adjust to them and move forward. See our Coping with Cancer pages for more tips. If you need to, ask your doctor to suggest a counselor who you can talk with about your feelings.
Many people find that staying active can help their self-image. Some things you can try are:
- Walking or running
- Playing a sport
- Taking an exercise class
- Weight training
- Stretching or yoga
You may find that being active helps you cope with changes. It can reduce your stress and help you relax. It may also help you to feel stronger and more in control of your body. Start slowly if you need to and take your time. If needed, ask a trainer at your local gym or a physical therapist for tips. Talk with your doctor about ways you can stay active.
Hobbies and volunteer work can also help improve your self-image and self-esteem. You may like to read, listen to music, do crossword or other kinds of puzzles, garden or landscape, or write a blog, just to name a few. Or you could volunteer at a church or a local agency, or become a mentor or tutor, for example. You may find that you feel better about yourself when you get involved in helping others and doing things you enjoy.
Changes in Your Sex Life
It's common for people to have problems with sex because of cancer and its treatment. When your treatment is over, you may feel like having sex again, but it may take some time. Sexual problems can last longer than other side effects of cancer treatment. It's important to seek help in learning how to adapt to these changes.
Until then, you and your spouse or partner may need to find new ways to show that you care about each other. This can include touching, holding, hugging, and cuddling.
Sexual problems are often caused by changes to your body. Depending on the cancer you had, you may have short-term or long-term problems with sex after treatment. These changes result from chemotherapy, radiation, surgery, or certain medicines. Sometimes emotional issues such as anxiety, depression, worry, and stress may cause problems with sex.
What types of problems occur? Common concerns are:
- Worries about intimacy after treatment. Some may struggle with their body image after treatment. Even thinking about being seen without clothes may be stressful. People may worry that having sex will hurt or that they won't be able to perform or will feel less attractive. Pain, loss of interest, depression, or cancer medicines can also affect sex drive.
- Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that also change your sex life.
- Some men can no longer get or keep an erection after treatment for prostate cancer, cancer of the penis, or cancer of the testes. Some treatments can also weaken a man's orgasm or make it dry. Less common problems include being unable to ejaculate or ejaculation going backward into the bladder.
- After cancer treatment, some women find it harder, or even painful, to have sex. While some cancer treatments can cause these problems, there may be no clear cause. Some women also have pain or numbness in their genital area.
- Having menopause symptoms. When women stop getting their periods, they can get hot flashes, dryness or tightness in the vagina, and/or other problems that can affect their desire to have sex.
- Losing the ability to have children. Some cancer treatments can cause infertility, making it impossible for cancer survivors to have children. But keep in mind that:
- Depending on your age, the type of treatment you received, and the length of time since treatment, you may still be able to have children.
- Families can come together in many ways. Some people choose adoption or surrogacy. Some people get involved in the lives of nieces or nephews, or in child mentoring programs.
- You may choose to focus on other interests and passions in life.
- You can reach out to your health care team with questions or concerns, as well as to professionally led support groups. Or you can contact Livestrong Fertility for more information, and for referrals to fertility programs in the United States.
For more details on fertility, see NCI's Side Effects pages.
Ask for Help
Even though you may feel awkward, let your doctor or nurse know if you're having problems with intimacy or sex. There may be treatments or other ways you and your loved one can give each other pleasure. If your doctor can't talk with you about sexual problems, ask for the name of a doctor who can. Some people also find it helpful to talk with other couples.
Sexual problems may not always get better on their own. Sometimes there can be an underlying medical problem that causes changes. Common changes and some solutions are:
- Erection problems. Medicine, assistive devices, counseling, surgery, or other approaches may help.
- Vaginal dryness. Dryness or tightness in the vagina can be caused by menopause. Ask whether using a water-based lubricant during sex, using vaginal dilators before sex, and/or taking hormones or using a hormone cream are options for you.
- Muscle weakness. You can help strengthen muscles in your genital area by doing Kegel exercises. This is when you practice controlling your muscles to stop the flow of urine. You can do these exercises even when you are not urinating. Just tighten and relax the muscles as you sit, stand, or go about your day.
Other issues you may want to talk about include:
- Concerns about having children. Discuss family planning concerns with your doctor. If you're a woman, ask if you still need to use birth control, even if you are not getting your period.
- Talking with a counselor. Some people find that sexual problems related to cancer start to strain their relationship with their partner. If this is the case, ask a nurse or social worker if you can talk to a counselor. Talking to someone alone, or with your partner, may help.
- Seeing a specialist. A sex therapist may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.
Tell Your Partner How You Feel
Talking to your loved one and sharing your feelings and concerns is very important. Even for a couple that has been together a long time, it can be hard to stay connected.
Let your partner know if you want to have sex or would rather just hug, kiss, and cuddle. He or she may be afraid to have sex with you. Or your partner may be worried about hurting you or think that you're not feeling well.
Talk to your partner about any concerns you have about your sex life. Be open about your feelings and stay positive to avoid blame.
Finding Ways to Be Intimate
You can still have an intimate relationship in spite of cancer. Intimacy isn't just physical. It also involves feelings. Here are some ways to improve your intimate relationship:
- Focus on just talking and renewing your connection.
- Protect your time together. Turn off the phone and TV. If needed, find someone to take care of the kids for a few hours.
- Take it slow. Plan an hour or so to be together without being physical. For example, you may want to listen to music or take a walk.
- Try new touch. Cancer treatment or surgery can change a patient's body. Areas where touch used to feel good may now be numb or painful. Some of these changes will go away. Some will stay. For now, you can figure out together what kinds of touch feel good, such as holding, hugging, and cuddling.
Feeling Intimate after Treatment
Although cancer treatment may be over, sexual problems may remain for a while. But you can find other ways to show that you care about each other. Feeling close to your partner is important.
- Be proud of your body. It got you through treatment!
- Think of things that help you feel more attractive and confident.
- Focus on the positive. Try to be aware of your thoughts, since they can affect your sex life.
- Be open to change. You may find new ways to enjoy intimacy.
If you're single, body changes and concerns about sex can affect how you feel about dating. As you struggle to accept the changes yourself, you may also worry about how others will feel. For example, you may wonder how someone will react to physical things, such as hair loss, scars or ostomies. Or it can feel awkward to bring up sexual problems or loss of fertility, which can make feeling close even harder.
Starting to date again may feel like a challenge. You may wonder how and when to tell a new person in your life about your cancer and body changes. For some cancer survivors, the fear of being rejected keeps them from seeking the social life they would like to have. Others who choose not to date may face pressure from friends or family to be more sociable. Here are some ideas that can make it easier to get back into social situations:
- Focus on activities that you have time to enjoy, such as going to festivals and group outings, taking classes or joining a club.
- Try not to let cancer be an excuse for not dating and trying to meet people.
- Wait until you feel a sense of trust and friendship before telling a new date about your cancer.
- Talk to your friends about dating or get advice from other cancer survivors.
Think about dating as a learning process with the goal of having a social life you enjoy. You get to choose who or how often you date. And not every date has to be perfect. If some people reject you (which can happen with or without cancer), you have not failed. Try to remember that not all dates worked out before you had cancer. And perhaps, your cancer experience gives you a sense of purpose and appreciation for a relationship that you didn't have before.